Table 2:

Quotations representing the theme of system-level impacts

Subtheme	Descriptive codes	Exemplar quotations
Health care resources	Access Hesitancy	“Yeah, the only thing that I had to do, which was continuous since I had the catheter first put in, was going every 4 weeks and have it changed … The only thing that changed on that, is that the health unit out here, instead of me going to them, they came to my home to change the catheter.” [Participant 2] “I had a conversation with my doctor, but she just did it over the phone, rather than making me go into the office. I just talked to her about that it is delayed, and you know that I would continue to take pain medication for it, but I have not had to visit any emergency room because of it.” [Participant 8] “I did have an incident where I should … could have gone in but I just decided not to. And yeah, just the waiting around in the emergencies just driving me crazy.” [Participant 10] “And once I was able to walk and talk, they wheeled me out into a hallway in the neuro ward. And I spent 2 weeks outside of a room, in a hallway at [hospital]. That was pretty uncomfortable. I’ve definitely seen what the effects of lack of bed availability looks like.” [Participant 13]
Health care provider	Access Communication Responsibility	“I don’t know about the avoiding delay, but I do definitely think it’s a system and set a cut-off time. For example, if we are a go as of 2:00 pm the day before surgery, we’re not going to cancel it. In other words, not waiting until the last minute to cancel and have a cut-off time the day before. So at least that person isn’t scared to go into the hospital the next morning and being afraid they’re going to be kicked back out.” [Participant 12] “They just said, ‘We’ll just have to wait. We’ve got no idea what a realistic timeline is, and we’ll keep you updated.’ So, I really have no expectations to hearing from them, until they know more. And I don’t really have expectations of things getting better anytime soon.” [Participant 13] “When the surgery was cancelled, I didn’t think to ask, but I also was not instructed what to do in terms of if I’m experiencing particular symptoms, whether that means I should go to the [emergency department], that kind of thing. So, I’ve just been suffering through it on my own, I guess.” [Participant 14]
Communication	Policy Government Health care provider Media	Interviewer: How do you think the people that were making the decisions could do a better job in the future? “I guess they could be more consistent … like they come out and say one thing and then they come out and say another thing. You know.” [Participant 6] “That just speaks to leadership, again, I think it just sent so many false messages, so many confusing messages.” [Participant 11] “And I probably shouldn’t say that, but he’s a bit of a dick. So, the thyroid doctor, he showed no mercy, he showed no kindness, he was just a jackass but his assistant was amazing.” [Participant 10] “I definitely feel like giving more notice that a surgery’s going to be cancelled. Less than 24 hours’ notice is just not enough time for a person. I think it’s more emotionally devastating to be right on the cusp of finally dealing with the situation, and having it cancelled. So, I think giving a more advanced notice of cancellations would’ve been better.” [Participant 12] “I did connect with the oncology clinic and they’ve been super about it, um, but I have nothing but praise for that clinic overall in terms of how they keep you informed and stuff like that so that’s been good.” [Participant 1] “I was impressed, I got a phone call right, like, from the doctor, which it wasn’t just a, like, a nurse or a clinic staff or someone like that. So, it was a personal phone call and she just apologized and said there was nothing she could do, and she would get back in touch with me when she could.” [Participant 5]
Accountability and responsibility	Understanding Frustration Anger Communication Vaccination Public policy Government Health care system	“Overall, this is a massive public policy failure.” [Participant 3] “Well, I mean, I understand that they had to maintain space in the health care system for COVID patients. And be able to create more ICU space, as is necessary, so I totally understand the rationale and thankfully I’m not speaking from the perspective of, say, a brain cancer patient where getting that surgery done now is so, so important. I think my perspective would be different if that were the case, but my surgery was one that could afford to be delayed and I recognize the need for it to have been based on having to keep beds available for those COVID patients.” [Participant 4] “I wish that things with regards to the pandemic had been handled much differently so that, potentially, patients and the hospital staff wouldn’t have been put in this situation.” [Participant 5] “I’m disappointed, but also understanding. Like, I understand the reason needed for it, I understand why the hospitals are not doing surgeries right now. I don’t hold ill will to the health care system.” [Participant 8] Interviewer: Did you think there was alternate options, maybe, like, something else they could have done in your eyes? “I think more restrictions earlier on would definitely be an alternative.” [Participant 8] “Our health care system is suffering, and I feel like the people that are making these decisions might be prioritizing social aspects before medical ones.” [Participant 8] “In my particular surgery, the chances of going to ICU after surgery were nil, very small. And so, I feel like my surgery could have been done, without adding to the ICU problem of being overcrowded. So, I think some of the surgeries that, in a limited quantity, should still have been done.” [Participant 12]

Note: ICU = intensive care unit.